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  • Madagascar: 2018/2019 Measles

    Source: https://reliefweb.int/disaster/ep-2018-000417-mdg


    Madagascar: Measles Outbreak - Oct 2018 Alert
    Overview

    Madagascar has been experiencing a measles outbreak since early October 2018. The outbreak started in the urban health district of Antananarivo Renivohitra (in the heart of the capital city, Antanarivo) on 4 October 2018 when three measles cases were confirmed at the Pasteur Institute of Madagascar (IPM) by serology. The disease then spread to other health districts (Tanà South, Tanà North and Ambohidratrimo) in Analamanga Region (where the capital city is located) and subsequently to other parts of the country. The Ministry of Public Health formally declared the measles outbreak on 26 October 2018.

    As of 18 November 2018, a total of 3 239 measles cases have been reported, of which 182 were confirmed immunoglobulin M (IgM) positive and 3 057 were epidemiologically linked. No deaths have been reported to date...

  • #2
    Source: http://outbreaknewstoday.com/madagas...-region-92244/



    Madagascar measles outbreak grows, 2/3 of cases from Analamanga region
    by News Desk
    December 28, 2018

    In a follow-up on the measles outbreak in Madagascar, local media reports (computer translated) the outbreak case total has risen to 15,049 cases since Oct. 1.

    About 65% of these cases were reported in the Analamanga region. 48 districts in Madagascar are affected by the measles epidemic during the last three months, six of which recorded more than 400 cases...

    Comment


    • #3
      Translation Google

      Ambato Boeny - Dozens of measles deaths reported

      Ambato-Boeny is the second district heavily affected by the measles epidemic. Local authorities report several dozen deaths in a few months.

      We are witnessing several deaths of measles during our raids in the bush in the last two months. We have seen and heard of at least sixty dead. We even saw three people from the same family, die simultaneously, "said a source at the National Gendarmerie Ambato Boeny yesterday. A source from the National Police of this district indicates, also, that this disease makes several victims, in the chief place of the district. Another source hammers out: "We recorded at least one death a day in the urban district of Ambato Boeny, in two months. Sometimes this number of deaths rises to five per day.
      ...
      https://www.lexpressmada.com/04/01/2...eole-signales/
      -------------------------------------------------- -

      Measles outbreak - Population distress call

      January 5, 2019
      ...
      Several people from across the island are sounding the alarm about the vulnerability of measles management. A distress call is launched in the face of insufficient inputs, health workers, care infrastructure, the cost of treatment. "If we continue like this, and as long as there are no drastic measures to stop the transmission of this disease, many will die," calls a health staff who remained anonymous. At the Analakininina hospital in Toamasina, ten people are suspected of succumbing to the disease. in Mahajanga, the medical inspector reports three deaths. in Ambato Boeny, local sources speak of a "hundred deaths", in the bush and in the city. In Antananarivo-ville, cases of measles deaths are also notified, without an exact figure. There would also have been deaths in other districts such as Antsohihy, Morondava.
      ...
      https://www.lexpressmada.com/05/01/2...la-population/
      "Safety and security don't just happen, they are the result of collective consensus and public investment. We owe our children, the most vulnerable citizens in our society, a life free of violence and fear."
      -Nelson Mandela

      Comment


      • #4
        Translation Google

        Epidemic - Many infants die from measles.

        January 10, 2019. Miangaly Ralitera

        The Ministry of Public Health officially reports the deaths of sixty-seven measles victims. Most are infants.

        Measles has been the cause of death of several infants since the outbreak of the disease, according to the report of the Secretary General of the Ministry of Public Health, Professor Arsene Ratsimbasoa in Ambohidahy yesterday. "90% of these victims are between 9 and 11 months old. They are, generally, unvaccinated children. And they received treatments only late. They were only brought to the hospital when their disease has evolved dramatically, "he describes. These cases have been reported at health facilities in Antananarivo-city, Ambato Boeny, Marovoay, Mahajanga, Toamasina, among others.

        Some have succumbed in a hospital bed, others are corpses in deposit. Community deaths such as those in Anosipatrana, Andoha-tapenaka, and Ambato Boeny are not included in this report.
        ...
        https://www.lexpressmada.com/10/01/2...e-la-rougeole/
        "Safety and security don't just happen, they are the result of collective consensus and public investment. We owe our children, the most vulnerable citizens in our society, a life free of violence and fear."
        -Nelson Mandela

        Comment


        • #5
          Source: https://www.who.int/csr/don/17-janua...madagascar/en/
          Measles – Madagascar

          Disease outbreak news
          17 January 2019

          WHO is supporting the Ministry of Public Health of Madagascar to respond to an unusually large measles outbreak. Madagascar last experienced measles outbreaks in 2003 and 2004, with reported number of cases at 62 233 and 35 558, respectively. Since then, the number of reported cases had sharply declined until the current outbreak. From 4 October 2018 to 7 January 2019, 19 539 measles cases and 39 “facility-based” deaths (case fatality ratio: 0.2%) have been reported by the Ministry of Public Health (MoH) of Madagascar. Cases were reported from 66 of 114 total districts in all 22 regions of Madagascar. Among the 19 539 measles cases, 375 have been laboratory confirmed (all are IgM+) and 19 164 were confirmed by epidemiological link. Cases confirmed by epidemiological link are those who presented clinical symptoms based on the case definition and had been in contact with another laboratory confirmed or epidemiologically linked case. The outbreak has spread to densely populated urban cities including Toamasina, Mahajanga, Antsirabe, Toliara and the capital city Antananarivo. Most cases were reported from Analamanga (61%) and Boeny (20%) regions. The highest attack rates were observed in Antananarivo-Renivohitra district (714 per 100 000 inhabitants), and Ambato-Boina district (668 per 100 000 inhabitants), in Analamanga and Mahajanga regions, respectively. These rates are considerably higher compared to the national attack rate of 108 per 100 000 inhabitants.
          In the current epidemic, children aged 1 to 14 years account for 64% of the total number of cases. The age distribution in this group is as follows: under five years at 35%, 5-9 years at 22% and 10-14 years at 19%. Both sexes are equally affected with a male to female ratio of 1.04. The national immunization programme recommends routine measles immunization for children aged nine months. According to WHO and the United Nations International Children’s Emergency Fund (UNICEF), the estimated measles immunization coverage in Madagascar was 58% in 2017. More than half of the cases (51%) reported during the current outbreak have not been vaccinated or have unknown immunization status. Madagascar has the highest proportion of malnutrition among children under five (47%) in the African region which can increase children's risk of serious complications and death from measles infection.
          The circulating genotype for the current measles outbreak in Madagascar is B3, usually found in Africa and Europe. No measles cases with travel history to Madagascar, however, have been reported in neighboring countries and initial investigations in Madagascar have not shown any link with cases from countries with measles outbreak in the Africa region or Europe.
          The measles outbreak has occurred concurrently with the resurgence of plague in the country—which reoccurs seasonally—straining the public health response.
          Public health response

          The Ministry of Public Health of Madagascar is coordinating the response activities, with the support of WHO and other partners. Public Health response measures include:
          • Enhancement of active surveillance (active case finding, community-based surveillance, distribution of specimen collection kits) in all affected districts.
          • Use of the Global Measles Programmatic Risk Assessment Tool to target priority districts for vaccination.
          • Completion of targeted vaccination campaigns:
            • Campaign conducted from 22 October to 9 November 2018 in four districts of Antanavarivo city. The campaign targeted at least 95% of children aged between nine and 59 months. Preliminary results show coverage of 84% of the targeted population.
            • Campaign planned from 14 to 18 January targeting 2 083 734 children aged between nine months and nine years in 25 districts across 13 regions. The campaign is being funded by Measles Rubella Initiative (MRI), the Government of Madagascar, WHO, UNICEF, Catholic Relief Services (CRS), Commission de l'Océan Indien (COI), the United States Agency for International Development (USAID), the Embassy of France in Madagascar and the World Bank and the total cost is US$ 2 355 989.
          • Reinforcement of routine immunization (one dose of measles-containing vaccine (MCV) as per the national immunization programme) for children aged between nine and 11 months.
          • Continued management of severe measles cases in referral hospitals, provided to patients free of charge. Vitamin A is being administered to patients under care in all referral and district health centres.
          • Continued community mobilization with the support of UNICEF and USAID, aiming to increase understanding of the disease as well as uptake of the vaccines from campaigns and routine vaccination.
          • Reactivation by USAID of the 910 hotline, formerly used during the 2017 plague epidemic, for information sharing on measles.
          WHO risk assessment

          Measles is an acute, highly contagious viral disease that has potential to lead to major epidemics. Low coverage with measles vaccine combined with a low incidence of measles in recent years in Madagascar has contributed to a significant proportion of the population which is susceptible to measles. According to WHO and UNICEF estimates, the measles immunization coverage in Madagascar was 58% in 2017. The malnutrition rate is also a contributor as malnutrition increases children's vulnerability of serious complications and death from measles infection.
          WHO estimates the overall risk for Madagascar from this measles outbreak to be very high. Currently, several concomitant factors are likely to hinder or delay public health intervention and might jeopardize the response: post-election conflict, geographical isolation and remoteness of cases, insecurity, hurricane season and multiple outbreaks. Targeted immunization campaigns and strengthening of routine immunization activities are paramount in the effective control of the outbreak. Administration of Vitamin A, specifically in a context of high rates of malnutrition, can reduce illness and deaths from measles infection.
          The risk at the regional level is low although the spread of measles to neighboring Indian Ocean islands and other African countries and Europe cannot be excluded. Strengthening of surveillance in neighboring countries is recommended. The overall global risk is considered to be low.
          WHO advice

          WHO urges all Member States to:
          • Vaccinate to maintain coverage of 95% with two doses of MCV.
          • Vaccinate at-risk populations (without proof of vaccination or immunity against measles and rubella), such as health workers, people working in tourism and transportation (hotel and catering, airports, taxi drivers, etc.), and international travelers.
          • Maintain a reserve of MCV and syringes for control of imported cases in each country in the region.
          • Strengthen epidemiological surveillance of fever or rash cases for timely detection of all suspected cases of measles in public and private healthcare facilities and ensure that samples are received by laboratories within five days of being taken.
          • Provide a rapid response to imported measles cases through the activation of rapid response teams to prevent the establishment or reestablishment of endemic transmission.
          • Administer vitamin A supplementation to all children diagnosed with measles to reduce the complications and mortality (50,000 IU for a child <6 months="" of="" age,="" 100,000="" iu="" for="" children="" 6-12="" months="" of="" age="" or="" 200,000="" iu="" for="" children="" 12-59="" months);="" two="" doses,="" immediately="" upon="" diagnosis="" and="" on="" the="" following="">
          WHO does not recommend any restriction on travel and or trade to Madagascar based on the information available on the current outbreak.
          For more information on Measles, please see the link below:

          Comment


          • #6
            Translation Google

            Measles epidemic: a death toll of 80

            Thursday, January 24 | Arena R.

            The record of the measles epidemic in Madagascar is heavy. 80 deaths related to this disease have been recorded across the Big Island in recent times. Most of them are children. These statistics from the Ministry of Public Health have been recorded in public hospitals. They do not take into account deaths that are not officially declared or patients who have not joined the public health centers.

            These statistics make measles the second most deadly epidemic after plague in Madagascar in the last three years. In 2017, the plague killed more than 200 people across the country. It is not only that these two diseases that are fatal, especially in this rainy season, there are the other diseases related to insalubrity or carried by mosquitoes such as dengue which strikes especially the sister island, The meeting.

            More than 70 districts out of 119 existing on Malagasy soil would have been affected by the measles epidemic, in only a few months. And the disease is spreading everywhere in the surrounding islands, including Reunion Island where its introduction on the territory was reported by local authorities a few days earlier.

            To prevent measles, the Malagasy Ministry of Health has already carried out a major vaccination campaign. According to a physician in charge in the ministry, 94% of children aged 9 months to 9 years in the affected districts were vaccinated in a few days during the first phase of the campaign.

            As in the fight against the spread of plague in the country, the Ministry of Health shows that it is strongly mobilized to deal with the epidemic. Nevertheless, he is not immune from criticism, both from relatives of patients and national observers in general. The lack of communication, even transparency and the retention of information on the evolution of the epidemic is one of the main reasons that many overwhelm this ministerial department.

            https://www.madagascar-tribune.com/E...-80-morts.html
            "Safety and security don't just happen, they are the result of collective consensus and public investment. We owe our children, the most vulnerable citizens in our society, a life free of violence and fear."
            -Nelson Mandela

            Comment


            • #7
              Translation Google

              Measles outbreak - Mampikony: Ten deaths recorded

              Redaction Midi Madagasikara January 29, 2019
              ...
              The measles epidemic in the Mampikony-Mahajanga district continues to wreak havoc. Ten deaths, mostly children, were found outside the basic health services, it was reported last week, during the "vaovaom-paritra" - reporting echoes of the regions - on the national radio. The latter also reports the unavailability of vaccines in these unsupplied health centers. A context that is not to stop or at least mitigate the measles epidemic in this locality.
              ...

              http://www.midi-madagasikara.mg/soci...s-enregistres/
              "Safety and security don't just happen, they are the result of collective consensus and public investment. We owe our children, the most vulnerable citizens in our society, a life free of violence and fear."
              -Nelson Mandela

              Comment


              • #8
                Translation Google

                Public health

                More than alarming!

                Saturday, February 2 | Fanambinantsoa
                ...
                Of the 28,747 cases of measles officially recorded by the Ministry of Health in the whole territory at the end of January 2019 and despite the vaccination campaign there were 80 deaths including one (1) in Morondava prison .

                In the latter case, the officials recorded about fifty people in custody with measles, of which about fifteen are in intensive care at the prison infirmary. Immunization campaigns are conducted but prison officials deplore malnutrition and undernourishment and promiscuity. The prison of Morondava like that of Antanimora in the capital is more than saturated. Planned for 250 individuals, Morondava prison houses 621 residents ...

                https://madagascar-tribune.com/Plus-qu-alarmant.html
                "Safety and security don't just happen, they are the result of collective consensus and public investment. We owe our children, the most vulnerable citizens in our society, a life free of violence and fear."
                -Nelson Mandela

                Comment


                • #9
                  Translation Google

                  Measles outbreak

                  266 deaths since September, emergency meeting in Mahazoarivo


                  Monday February 4th | Arena R.

                  An emergency meeting on the measles epidemic was held at the Mahazoarivo Palace in the afternoon of Saturday. Indeed, the epidemiological situation of recent times is enough to alarm more than one. The report, submitted by the Ministry of Health, reports 266 deaths notified and verified from 3 September 2018 to 1 February 2019. Most of these deaths are community cases, that is, say that the families of sick people are reluctant to join hospitals or health centers and prefer to approach traditional healers or self-medication.

                  In five months, 39,366 cases were recorded. 665 of them were confirmed IgM +, that is to say, direct cases, and 38,701 cases by epidemiological link. 86 districts out of 114 or 75% of the health districts of Madagascar are affected by this epidemic. If all 22 regions of the island are affected by this epidemic, the East and North parts of the Big Island, especially the Atsinanana and Diana regions are more vulnerable hence the holding of this emergency meeting at the Primature particularly concerning these two communities.

                  Statistics from the Ministry of Health reveal that 31% of registered cases are in the age group of 5 to 14 years, 25% of 1 to 4 years and 13% of 15 to 19 years. 56% of reported cases are also unvaccinated and of unknown status. And currently, four cases of measles imported from Madagascar were recorded in Reunion which Friday Friday 22 confirmed cases, according to the report of the Agency for the Health of the Indian Ocean (ARS OI).

                  Mobilization of technical and financial partners

                  The meeting in Mahazoarivo, led by the Prime Minister, saw the mobilization of Madagascar's technical and financial partners, such as WHO, UNDP, UNICEF and OCHA, as well as some members of the government, such as the Minister of Health, the Interior and Decentralization, the Minister of Economy and Finance and the Minister of Communication and Culture. To cope with this alarming situation, the rapid intervention teams of the Ministry of Public Health, set up at the level of each commune, were reactivated as early as yesterday to identify patients in the communities and make them benefit from the health care kits. care, even if they do not go to the hospital.

                  Both the authorities and the partners seem to have recognized through this meeting that the Ministry of Trustees lacks information and data on the actual situation of the reported cases. This situation would have made the tasks of the Ministry of Health difficult, because it "does not allow for the moment to determine the global needs on the care of the patients". Thus, Christian Ntsay has given clear instructions that this data will be available no later than next Tuesday when a new emergency meeting will be organized in order to make all necessary decisions.
                  ...

                  https://www.madagascar-tribune.com/2...hazoarivo.html
                  "Safety and security don't just happen, they are the result of collective consensus and public investment. We owe our children, the most vulnerable citizens in our society, a life free of violence and fear."
                  -Nelson Mandela

                  Comment


                  • #10
                    Source: https://www.cnn.com/2019/02/07/healt...eak/index.html

                    Tens of thousands infected in measles outbreak in Madagascar
                    By David McKenzie and Brent Swails, CNN
                    Updated 8:35 AM ET, Thu February 7, 2019

                    Antananarivo, Madagascar (CNN)Measles found Hasina Raharimandimby and her family. Over three heartbreaking days in late January, three of her young children died of the virus.
                    "I miss taking them sweets and snacks for them whenever I came back home from work," she says. "We used to play and feed the birds near our home."

                    Madagascar, the island nation off the coast of East Africa, has been hammered by its worst measles outbreak in decades. The secretary general of the ministry of health told CNN that more than 50,000 people have caught the disease since October 2018 and there have been more than 300 deaths -- mostly children...

                    Comment


                    • #11
                      Translation Google

                      Measles outbreak - More than three hundred people died

                      February 7, 2019. Miangaly Ralitera
                      ...
                      "The fokontany leaders of Betaramamay and Antsopoka Bevoay asked me for help with the spread of disease in their locality. According to them, deaths occur every day. The one of Betaramamay has, for example, reported at least three deaths a day," said the mayor of the urban community of Ambato Boeny, Jean Valerian Rakotondrasoa, yesterday. In the same district, measles victims would fill the basic health center in Madirovalo commune. In the commune of Anjijia, deaths would also be notified ...

                      Three hundred and thirteen people died of the disease in 26 districts, according to a report by the Ministry of Public Health on 5 February.
                      ...
                      Fifty-three thousand four hundred and fifty-nine people have contracted the virus, since the first case recorded in June ...

                      https://www.lexpressmada.com/07/02/2...nnes-decedees/
                      "Safety and security don't just happen, they are the result of collective consensus and public investment. We owe our children, the most vulnerable citizens in our society, a life free of violence and fear."
                      -Nelson Mandela

                      Comment


                      • #12
                        Source: https://www.independent.co.uk/news/w...-a8780781.html

                        Measles outbreak kills almost 1,000 children in Madagascar despite emergency vaccination scheme
                        The Indian Ocean island has Africa’s highest rate of children’s malnutrition, increasing health risk from measles infection
                        Stephanie Nebehay
                        3 hours ago

                        At least 922 children and young adults have died of measles in Madagascar since October, despite a huge emergency vaccination program, the World Health Organization (WHO) said on Thursday.

                        The number of deaths is based on official numbers, but these are likely to be very incomplete, as is the current total of infections, at 66,000, Dr Katrina Kretsinger of WHO’s expanded program on immunization told a news briefing...

                        Comment


                        • #13
                          Translation Google

                          Nearly 1,100,000 children from 6 months to 9 years targeted by the second phase of measles response vaccination campaigns in Madagascar

                          The Republic of Madagascar is continuing to implement the priority interventions for the rapid control of the measles epidemic declared in October 2018. Since the beginning of the epidemic and as of February 15, 2019, a total of 68,912 cases have been reported. by the Ministry of Health, including 553 deaths in health facilities and 373 other community deaths. The response to this epidemic is articulated around six strategic axes namely, rapid reinforcement of immunity of children through vaccination campaigns, case management, epidemiological surveillance, risk communication, revitalization of routine immunization and coordination.

                          The planned three-phase vaccine response targets more than 5 million children from 6 months to 9 years of age. After the first phase of vaccination organized from 14 to 18 January 2019 and which allowed to vaccinate more than 2 110 633 children, the second phase started this Monday, February 18, 2019.

                          Launched on 03 February by HE Andry Rajoelina, President of the Republic of Madagascar, in the Diana Region in the north of the country, the current campaign concerns 22 health districts. Under the coordination of the Ministry of Public Health, WHO and partners have mobilized for a quality vaccination campaign.

                          Faced with the many cases of measles, the demand of the population has been pressing in recent weeks. Many people have called for measles immunization both in communities and on social networks. "When will vaccinators come to our community? Many parents expressed concern to protect their children against this often harmful disease.

                          To cope with the epidemic, the Ministry of Public Health mobilized all national and international partners. In his message to the people, Professor Julio Rakotonirina, Minister of Public Health, said that "vaccination against measles is, and remains free. All parents are invited to vaccinate their children during the campaign, in the health districts targeted for this phase »

                          The response to the epidemic requires resources, and to date, there are still financial gaps to implement both the last phase of vaccination and other strategic areas. "We continue to encourage national partners and the international community to fund the response to the current measles epidemic," said Pr Charlotte Ndiaye, WHO Representative in Madagascar.

                          Many patients pay a heavy price for the disease. Major actions are underway to improve the quality of case management to reduce the risk of death.

                          While the current immunization campaign aims to respond to the country's never-ending measles epidemic for a decade, it is important to remember that routine immunization remains the key strategy to effectively combat measles and all other preventable diseases. Vaccination. Also, a vaccination revitalization plan is being finalized and will be implemented in all regions.

                          At the end of this vaccination campaign, more than 3 million children from 6 months to 9 years old will be protected against measles in 47 out of 114 districts in the country. Four million children will be targeted at the 67 health districts remaining in the coming months with the last phase of the vaccination response campaign.

                          Interventions being implemented by the Ministry of Health, WHO and partners are beginning to bear fruit. The overall trend of the epidemic is declining in all affected areas. Strengthening the actions underway will put an end to this epidemic.


                          https://www.afro.who.int/fr/news/pre...s-campagnes-de
                          "Safety and security don't just happen, they are the result of collective consensus and public investment. We owe our children, the most vulnerable citizens in our society, a life free of violence and fear."
                          -Nelson Mandela

                          Comment


                          • #14
                            Translation Google

                            In Madagascar, the difficult fight against a deadly measles epidemic

                            First publication: 10/03/2019 - 09:47
                            ...
                            The latest statistics from the World Health Organization (WHO) are chilling. From September to February, more than 79,000 cases of measles were recorded in Madagascar, including 926 deaths.
                            ...
                            "This is a major epidemic," says soberly Dr. Vincent Sodjinou, of the Malagasy antenna of WHO. "For almost a decade, vaccine coverage has not lived up to expectations and has increased the number of unprotected people over several generations."

                            The country's current vaccination rate is only 57%.

                            Measles is a mild infection if its symptoms such as fever and cough are treated in time.

                            Otherwise, opportunistic diseases - respiratory infections or diarrhea - benefit from the fragility of the patients. In Madagascar, where half (47%) of children under 5 suffer from chronic malnutrition, they are devastating.

                            "It is often said that malnutrition is the bed of measles," says Dr. Sodjinou.
                            ...
                            "Normally, we only treat one case of measles every two months," says its leader, Dr. Ravohavy Setriny Mahatsangy, "since December we are already at 444".

                            In the dock, he cites "social promiscuity, which facilitates the spread of the disease, the refusal to seek treatment in a hospital and reluctance to vaccination."
                            ...
                            The fight looks long and difficult. "Madagascar has set up a routine vaccination operation," says the WHO representative, "but this is still insufficient, especially to target the very remote areas of the country."

                            © 2019 AFP


                            https://www.france24.com/fr/20190310...ole-meurtriere
                            "Safety and security don't just happen, they are the result of collective consensus and public investment. We owe our children, the most vulnerable citizens in our society, a life free of violence and fear."
                            -Nelson Mandela

                            Comment


                            • #15
                              Translation Google

                              Epidemic - Measles kills 1,000 people

                              March 14, 2019
                              Miangaly Ralitera.
                              ...
                              Many losses in human lives. The figures on the measles situation, published by the Ministry of Public Health yesterday, are chilling. The disease kills one thousand and forty-one people between September 2018 and March 4, 2019. Most of the victims are children. Six hundred and thirty died at the health facility level and five hundred and eleven at the community level. In this same period, ninety-eight thousand four hundred and fifteen cases are notified...

                              In this report on the measles situation, the Ministry of Public Health emphasized the need for investigation of cases and deaths in the South-East and South-West region as well as capacity building for rapid response teams. . In both regions, measles caused many deaths in February. For example, the mayor of Ambahikily commune in the district of Morombe reported at the end of February "at least thirty deaths by fokontany". In Nosiala Manakara, the disease has claimed many lives in the same month.

                              ...
                              https://www.lexpressmada.com/14/03/2...-de-personnes/
                              "Safety and security don't just happen, they are the result of collective consensus and public investment. We owe our children, the most vulnerable citizens in our society, a life free of violence and fear."
                              -Nelson Mandela

                              Comment

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